ABSTRACT: This study examines the content of four academic sexuality journals to detect paradigm changes in therapeutic approaches to female sexual dysfunctions (sexual arousal disorder, orgasm disorder). A content analysis of articles appearing in the Journal of Sex Education and Therapy, the Journal of Sex & Marital Therapy, The Journal of Sex Research, and the Archives of Sexual Behavior was conducted for the years 1967 to 2000 in relation to the use of medical, psychological and biopsychosocial paradigms in sex therapy. The categories employed in the analysis were: journal; publication year; type of dysfunction; theoretical orientation; primary cause of dysfunction; and type of intervention. The results suggest that within the sexological literature, perspectives on the nature and treatment of female sexual dysfunction have shifted away from psychological explanations and more toward medical and biopsychosocial approaches. The implications for sex therapy are discussed.
Key words: Sex therapy Female sexual dysfunction Medical model Psychological model Biopsychosocial model Paradigm changes
Have sex therapy paradigms related to female sexual dysfunctions changed in the professional literature in the past 30 years? Some argue that sex therapy has become medicalized (Bass, 1994; Irvine, 1990; Tiefer, 1994; 1996; 2000; 2001). The medical model has become the dominant paradigm for the understanding and treatment of male sexual dysfunctions, most notably with respect to erectile dysfunction and premature ejaculation (Winton, 1993; 1996; 2000). The purpose of this research was to examine paradigm change in the study and treatment of female sexual arousal and orgasm disorders. An analysis of articles in major sexology journals that focus on female sexual dysfunctions will be used to trace the medical, psychological, and medical-psychological paradigms (Winton, 1997; 2001).
The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (American Psychiatric Association, 1994) defines female sexual arousal disorder as "persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual excitement" (p. 502), and female orgasmic disorder as "persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase ... "(p. 507). In addition, both disorders cause distress and interpersonal difficulty.
The epidemiological research indicates that the rates of female sexual disorders are high. In their landmark study, Laumann, Gagnon, Michael, and Michaels (1994) found that 18.8% of women have trouble lubricating and 24.1% are unable to have an orgasm.
The two major sex therapy paradigms in the treatment of female sexual dysfunctions are the medical and psychological (Hyde, 1990; Winton, 1997). In very general terms, a medical model of sexual dysfunction implies or assumes that a dysfunction is likely to have some organic basis, perhaps a medical condition, that requires a medically based treatment that may include medication or other pharmacological intervention. In contrast, a psychological model implies or assumes a psychogenic etiology rooted in intrapsychic, interpsychic or social factors that would more likely be amendable to a counselling-based therapeutic approach.
There has also been an increased interest in the biopsychosocial model (Plaut, 1998; Winton, 2000) which suggests the possibility or likelihood of a "mixed" etiology for sexual dysfunction that includes both biological/medical and psychogenic factors. Medical interventions include herbs (Cohen & Bartlik, 1998; Piletz et al., 1998), androgen-replacement therapy (Davis, 1998), phentolamine (Rosen, Phillips, Gendrano, & Ferguson, 1999), and sildenafil (Balon, 1999; Berman & Berman, 2000; Rosenberg, 1999). Psychological interventions include physical sensate focus exercises and a variety of counselling techniques (Heiman & Meston, 1997; Kaplan, 1987; Masters, Johnson, & Kolodny, 1982; Sarwer & Durlak, 1997; Winton, 1997). …